Insights

Posted on Tuesday, September 8, 2015 10:20 AM

NAHC has drafted comments that will be submitted in response to CMS' proposal to establish a 90 day episode "bundling" program in 75 MSAs focused on patients with complete knee and hip replacements. Under that CMS proposal, hospitals in the designated areas will face the opportunity for financial rewards and penalties when the overall Medicare spending on patients receiving joint replacements from their facilities are greater than or less than the established Target Price. Home health services and hospice care services are among those included within the "bundle."
Under the proposal, providers will continue to be paid under the current fees for services payment model applicable to their provider sector. NAHC clarifies that this means Medicare will still pay home health services under the current episodic prospective payment model and hospices under its per diem payment model. Additionally, patients will retain the freedom to choose any qualified provider of post-acute care. However, it will be in the interests of the hospitals to manage the inpatient and post-acute care to the best clinical and spending outcomes. Hospitals will be able to share both rewards and losses with other provider participants similar to the existing ACO demonstration programs.
The deadline for submitting comments to CMS is September 8, 2015.
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